Wherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.

Wednesday, January 31, 2007

It's Complicated: part one

One of the hardest things about being a surgeon is the inevitability of complications. It's true for any doctor; but with surgery, it's as if they are lit in neon and given a soundtrack. At least to me. Aiming for perfection (as do we all) and beating myself up (more than healthier people) when I miss the mark, I found bad outcomes of nearly any magnitude deeply disturbing. The big ones are there for lots of people to see: nurses on the surgical floor or ICU, operating room personnel when you have to re-operate. And of course, the patient. The family. My family, for that matter. Smaller problems might just be between me and the patient; but they still are painful. Carrying the responsibility for having done harm to people who gave me their trust can be nearly too much to bear. Thankfully rare, it's never been easy. Nor should it be.

I don't know the extent that I speak for other surgeons in this matter. I actually believe I took it too hard, and too personally; so what I say (which I'm sort of anxious to find out myself) may be fairly singular. But I got a specific request to tackle the subject, and I think it's an excellent one. So here goes.

There are two cardinal sins, in my estimation, for the general surgeon. The first, the sine qua non of a surgical screw-up, is injuring the common bile duct. Nailing the bowel with a suture while closing an abdominal incision is the other. Each tends to bespeak carelessness, and I'm sorry to say I've done both. Only once each, thank God, in what I'd conservatively estimate to have been around ten thousand operations (not all, of course, subject to those particular errors.) Actually the cardinal error -- more like the pope error -- of bile duct injury is to do it and not recognize it at the time. THAT, I've never done. Unrecognized bile duct injury can lead to a tragedy for the patient. If you're gonna ding it, at least see it at the time and fix it. That usually works out ok.

In the community of my first job as a surgeon, each newbie was subjected to a monitoring process in which every other surgeon in town was to scrub with him/her at least once at to render some sort of judgment. So the first time I was able to do a case unmonitored, I had the referring doc assisting me on a very routine gallbladder removal. It was the classic situation for injury: the easy case -- when the going is tough, you tend to have all the feelers out for problems. (I'd add, apropos a comment I received on my mini-gallbladder post implying it was the worst of all possible worlds, this was in the days of the big incision, and well before laparoscopic surgery.) My patient was a tiny woman, with tiny ducts. Her gallbladder had practically no length of duct connecting it to the main bile duct, so I thought I was dissecting the cystic duct (normally much longer, it's the tube that connects the gallbladder to the common duct), when in fact I was working my way down the common duct. Somewhere along the line, I discovered I'd cut it clean in half. As my heart sank and my hands got clammy with the realization, my forehead and armpits drenched themselves with sweat and I told the referring doc I'd be wanting to get my partner in to help at that point. He was only too happy to vacate. I repaired the duct -- among the smallest I've ever seen -- over a baby-sized T-tube, drained it, and closed up. And for the first time as a real doctor, I had to face my patient and tell her what happened.

It's excruciating. I hate everything about it. There is a very real temptation -- to which, even in this age of attorneys under every rock, some people still succumb-- to fudge it, not to tell it like it was, to protect oneself. In my case, I think, the urge is motivated less by fear of lawsuit than of confronting my own inadequacy. And the acute awareness that I'm telling a person things will not be as she expected; that her life could be very unpleasant for awhile. It's not what she signed up for, and it's my fault. Face to face. You're screwed. My fault.

I doubt I could successfully bullshit a person if I tried. My car got stolen when I was in med school. In the glove box was a small amount of what might be called an herbiferous stimulant (that it was small and had been in my glove box for months bespeaks the extremely limited use to which it was put.) For what may be the only time in the history of the local police, they found my car, and called me to pick it up at the station. Finding the glovebox contents strewn about the car, I noted it was all there; except for the one item. To the query if anything was missing, I said no. Couple of days later, there were two cops at my door, holding badges at eye level (narcotics boys) and asking for me. Had they just graduated from cop school, had they never seen a guilty person in their lives, they'd have known I was as guilt-ridden as if I were holding a bloody dagger. They displayed (holding it by a string: no fingerprints) the Alka-Seltzer bottle which held the offending material, and asked if I knew what it was. "Well," I said. "You guys being here and all, I suppose it's some sort of drug...." Fortunately, they also knew that the car had been stolen and there was no way to pin the contents on me. A stern warning was what I got, as my future career and my father's wrath passed before my forebrain: the one waning, the other waxing. I'm a lousy liar. (And since then [well, not too long after] a confirmed non-user.)

I told my patient truthfully what had happened, but I was not above trying to put it in the best light. Her anatomy was unusual, I explained, with her gallbladder so close to the bile duct that removing it left the duct damaged. True. But passively stated. To my retrospective regret (because it was less than entirely forthcoming), I glossed over the fact that I hadn't recognized the anatomy until I'd done the damage. I didn't lie. Yet I didn't resist the urge to sugar coat it. She was disturbed, but not beside herself: ultimately she had to put up with a capped-off tube with no drainage for three of months, after which it was gone and she had no further problems. (Being just out of training, I wrote to my professor to ask his advice about how long to leave the tube. In doing so, I said "I was recently called upon to repair a bile duct...." It was not untrue. I hoped he'd assume it was someone else's injury. He never said otherwise, but he was a very wise man.) It could have been much worse. As to the conversation I'd had with my patient, it's weighed on me ever since, and it was a long time ago. So many issues are at play in such a situation, it's hard to enumerate them, let alone fully understand them. I'll try.

The suture thing was quite different: the whole spectrum of terribleness, way worse for everyone. It had been a routine colon operation, and she'd gone home quickly, doing fine, only to come to the emergency a few days later, sick. My clamminess didn't take over right away, because my first instinct was to try to fool myself, to convince myself it wasn't what it was....

41 comments:

I have bloged lately about what I fear to be a major tendency to push individual responsiblity in medical training to the very back burners and replace it with team play,systems muddling,and signing out.I know the docs of your surgical generation and my internist cohort had individual responsibility branded for ever on the limbic cortex-or somewhere.Your current post really exemplifies that.

I have never seen the truth about an incident be as harmful as "almost" the truth. A couple of observations. The truth is easy to remember;and truth is a good defense. The "almost" truth leads to questions which almost always make the defendent look like what they are --a liar. I also applaud your position of "it was my error".

I appreciate this post but from the perspective of probably looking at a 4 hour open ABD surgery. It unnerves me when I read about all the potential complications but helps me to know there are surgeons who care so much about their patients. I admire everything surgeons do. You've all paid your dues to practice your profession and I think it takes guts (no pun intended) to be a surgeon. I am grateful for the surgeon I have had this past year. Because I am high risk I have to go to a larger hospital and even tho I've heard good things about the new surgeon, it is really difficult to leave the one that has worked with me all year. Oh well- one has to do what they have to do.

Your "Taking Trust" from back in Oct. is still my favorite post followed by The Independent Urologist's post called "Letter to the Editor". :)

It's true for every surgeon who is any good at all: you never forget the screwups. I've been retired for nearly a decade, and I still lie awake some nights reviewing one or another unhappy such circumstance; mostly they were relatively few and minor with no long-term consequences but, fortunately rarely, sometimes not.

interesting coincidence that you blog about the dreaded complications just as i blogged about the dreaded m and m where the complications are displayed for all to see. as far as coming clean about your mistakes, one of my colleagues once really wrecked the rectum of a patient because of total stupidity. his prof advised him not to present the case on the m and m because it was totally indefensable. he took the advice and remained mum. the stories of his blunder are still doing the rounds, but always behind his back. when i once (the first and i trust the last time) cut the common hepatic duct (i noticed my mistake and repaired it. the patient did well) my prof also advised me not to present it on the m and m. i thanked him for the advice and presented it anyway, owning up to what i'd done. that m and m was not fun. i felt terrible and even questioned what i'm doing in surgery if i screw up so severely. but it passed and there were no stories afterwards.

i realise this is seeing mistakes from our side as the surgeons and not addressing the patient's side of things, but this is because to most of us these blunders are very difficult to live with. i'm in no way disreguarding the patient. i'm just looking at it from my view for the moment.

my point is honesty is the best policy, even if it is not the easiest policy. i agree with james that the final responsibility must lie with me as the surgeon. there is a team, but it's my patient and i must take responsibility completely.

There's much I could say about the comment I just deleted, including the fact that it seems to be from the same person who has slithered over here before. I realized in venturing into this area I could stir up feelings in people who've had problems with their doctors. (This fellow's comments cover a far broader swath, however.) I'm trying to write honestly and personally about it, revealing my errors both of commission and omission, and -- as it is with writing -- to discover things about it myself. Were I perfect, there'd be no need for the series. As I've said before: I invite and welcome contrary comments. I expect to learn from them as well. I do not invite or tolerate degenerate personal attacks; most especially from people who (I can only assume) have no idea what I am really about.

In all honesty, I have to say this is a very emotional issue for me and my response may not be appropriate for this place - if you decide to delete it, I understand.

I had a life altering experience with a surgeon - which traumatized me both physically and emotionally. My poor outcome is a direct result of the surgeon not facing a situation that could have made her lose face with her colleagues (and herself, most likely). To this day, she will not admit that she grossly mishandled my situation.

I think the worst part of my experience is how it destroyed my self-esteem. The first few months of my recovery my inner voice just cried "why me?" "why did she hate me so much that she left me to die?" "I must not deserve to live?" "why bother?" I do not believe that she did anything wrong surgically, but she lacked a post-op follow-up policy which directly led to a severe case of inra-abdominal infection - a mess of SBO, sepsis, peritonitis, pneumonia, blood transfusions, acute pancreatitis - not my best days.

That is what I blame her for...for putting me through that experience only because she couldn't be bothered with post-op clinics. This abandonment destroyed my self esteem; not the fact that I had the infection but the fact that she refused to see me in follow-up and literally told me to deal with it however I saw fit - because, a "technically perfect" procedure didn't need ambulatory care (once discharged from the ward, she belived no follow-up care was needed).

This is why I am so touchy about the subject of surgeons not having long term relationships with their patients. My PCP just today mentioned that the problem with surgeons is that they do not have to treat their mistakes; that we just get pushed into primary care to deal with.....That is why I cannot help but think if a surgeon followed his patients after the surgery and longer than just a couple of months post-op (espcially with ICU patients) that a sense of responsibility and understanding of consequences may be heightened.

My philosophy with medicine is that I do not expect my surgeons and physicians to be perfect; but I do expect them to be up-front with me and to do whatever it takes to correct or minimize the effects of human error. I know no one is perfect; but how a person faces his / her mistakes and takes responsibility and is a true test of character.

I share my story in order to give you physicians and surgeons out there an understanding of how a short-time, routine encounter in your life, ends up being the turning point in another person's life journey. At the risk of hyperbole, my life ended at 40 - as a direct result of a deliberate act; not a minute goes by that I am not affected by her actions;and to her? as far as she is concerned, I don't even exist; I pass her in the hall and she is clueless to what she destroyed.

Ironically, Dr S was the first and only surgeon who has alluded that this was not a normal situation; that has actually eased my emotional turmoil. In my opinion, facing your mistakes as a care giver not only builds character in the one who erred but can be a powerful healing tool for the patient "wronged".

Anonymous: I'd never delete a post like yours. And I agree with everything you said. Especially the part about continuing to see patients for however long it takes. Frankly, the behavior of the surgeon you describe sounds WAY out of bounds and, I'd hope, very far from typical. I'm sorry you had to suffer so much.

Kudos to you, again - partly for the excellent post and the way you bring the human side out. But mostly for your willingness to admit an 'oops.' I think it's the single best approach in medicine - I find far more accepting patients and family members when I apologize for missing an IV than when I hear co-workers blame "rolling veins" or some such thing, or when I sheepishly apologize and admit I completely forgot to bring that cup of ice chips instead of making excuses...that kind of thing. I don't think there's anything wrong with being fallible or humble and a surgeon - it's the ones with the God-complex that scare me.

a great post, and fun to read. thanks for being genuine about the inhaling. none of us is perfect, and carelessness or random error run through us all the way down to our DNA. Unless errors are in spite, i think we all need to be forgiving of each other. lawyers probably wouldn't like that.

Medicine is the only profession where perfection (or at the very least,the absence of notable error) is the norm. It is inhuman, inhumanE, and unnatural. It defies the 2nd law of thermodynamics, and Mother Nature doesn't like her laws broken.

That said, I think you were on the "coming clean" methodology of damage control long before a JAMA or NEJM study proved its effectiveness quantitatively.

Sometimes even with the best of intentions Physicians and surgeons have things that go wrong. Why then do they try to cover it up instead of just explaining to you what went wrong so you can understand it.You know and they know you do and so do other medical personnel but it is all a deep dark secret sometimes to be discovered many years later after much uneeded suffering.

I have to say that I have experienced common bile duct injury and it has changed my life forever. My children suffered my husband and my mother passed only 2 months after my corrective surgery which I face in 10-15 years to do all ove again. The surgeon I had cut out two inches of common bile duct and he didn't catch it so let's just say I went through 3 hospitals no exaggeration.My surgeon acted all concerned until I got sent to another hospital then I was never his problem anymore. I commend you on your honesty but it is sad that my family and I have to suffer for years to come because of his mistake.

Wow. I'm late to the table as I just found Dr. Shwab's website. I find his take on surgery and the surgeon performing it fascintaing. So many complications riddled my husband's surgeries that I was convinced he would at some point demand to go to some place other than Duke. A teaching hospital. He never did. We always had confidence in our surgeons, but we always had frank discussions with them as well. We voiced our fears and concerns. No doubt having 12 fresh-faced kids in short coats peering over your bedside was a nuissance.....but we never considered leaving our doctor's care. How else do you make doctors other than letting them watch other doctors?

One of the comments said that you may have 10-15 years before your "replacement" bile duct has to be replaced. Is that a decent estimate? My surgeon was so cagey about it. He said he really couldn't say how long it would last. Also, how do you know when the replacement duct has closed up or is in the process of collapsing or something?

It's not something that always occurs. It depends in part on what sort of "replacement" was done. Things can scar down, making the opening narrow. If it happens, depending on the actual surgical anatomy, it might be solved by dilating it without an open operation; something done, depending on various things, by a radiologist or a gastroenterologist. As to signs, there could be some changes in lab work (liver tests), there could be jaundice, possibly infection. Ultrasound could see dilated ducts in the liver. But again, it may well never happen.

I too believe surgeons should bare the responsability of following up with patients, especially when they have made a mistake. My fiance's surgeon was all too quick to get rid of him after he made a mistake damaging his common bile duct during a "routine" laproscopic gall bladder surgery. He saw him twice. The second time he almost refused to see him because the insurance only covered 2 months of follow up care. (He was in ICU for 3.5 weeks after surgery then bed ridden for another month with a home nurse) The day of the surgery we waited 7 hours to speak to the surgeon after the surgery, eventually my fiance emerged the surgeon did not. In fact we, the family, did not hear from the surgeon until 2 days later after myfiance was rushed into ICU. The surgeon told us that a cat scan showed an awful lot of fluid in his abdomen and that he could have possibally damaged the bile duct during the surgery however he does not believen this to be the case and it is probabally the fluid he used to clean up the surgery. My fiance was raveged with infection, developed pneumonia, bed sores, extreme weight and muscle loss, lost alot of hair, and while in the hospital had tubes down his nose, and out his side draining bile. We suffered alot, we both lost our jobs due to this, and are struggling to et back on track. My credit ha plmmeted from 700 to I can only imagine what and we had to move in with family. He was unable to work for a substantial amount of time it took me 4 months to find a new job when I lost that one to having to take time off to care for him. One of his sutures had to be reopened and packed to drain infection. When he could finally see the surgeon he had 1 follow up a his office, the second one he was turned away saying he was passed the post op care period allotted-which he was past due to the mistake this surgeon caused- it was only when the surgeon realised he never had told my fiance to get the stent removed-that they inserted into the bile duct- that he had hid receptionists track him down through calling me and getting his cell # and telling him to turn around and come back to the office so he could tell him to get the stent removed. Then trying to get a surgeon involved to take out the stent was a nightmare no one wanted to get involved for fear of being dragged into a lawsuit. Finally the original surgeon got a doctor to remove it as a favor to him but the doctor wanted nothing more to do with it and wouldnt discuss anythung but the removal,and would not preform any catscans etc. to make sure the complications didnt still exist. We are still struggling to find a doctor to help us. He has returned to work even though he is still in daily pain. With shooting pains in his abdomen. This has been goin on since march and many tell us t will be at least a year before he gets the help he really needs due to peoples fears. All we really want is for him to get better and feel as best as e possibally can. We just want the truth as to his condition and what could be done to make it somewhat better. I applaud you Dr. S for being honest. It took my fiance becoming lethargic before the hospital realised something was wrong, they ignored his cries of pain and the fact that he was still there a day past expected release date-ultimately 24 days past when all was said and done.

On 11-12-09 I had a Lap Choley and went home. Over the next 24 hours, I got violently ill you know, nausea, vomitting along with severe pain. Upon returning to the ER, it was discovered that my liver enzymes and bilirubin were critically high. I was transferred to a larger hospital where the surgeon whom which done the procedure works. It took 2 days to discover that My common bile duct had been clipped. Initially, the surgeon was apologetic, and openly admitting what had happened. I even chose him to correct it. After finishing he had told my family that he removed the clips, (showed them photos of the clipped duct) and was able to spare my common bile duct without having to do the hepatojejectomy, forgive my spelling. three days later, they decided to place a stent, which took both a PTCA and an ERCP, which I had already gone through previously in attempt to diagnose the problem. I am a RN and work with this physician occasionally at a smaller hospital in a rural community where he comes in and performs these day surgeries once a week. Saying this, we had a working relationship in which he admitted that this made it even harder for him. I know he was devastated, I can tell by the looks on his face everytime he walked into my room. However upon my latest follow up visit he has now revoked the idea that it was clipped and says that he actually just kinked it and there was no damage to the duct. The Gastroenterologist as well as the radiologist and the surgeon himself specifically stated that he placed a surgical clip directly on the common bile duct throughout my hospital stay. he is also saying now that my cystic duct was "not anatomically correct" and it had a short neck. To me now I feel and know that he is starting to smooze over the truth to justify his error and this saddens me. I am starting to lose respect for this surgeon that I once thought highly of. The story has completely changed. In my opinion, honesty is the best policy and is usually the best route to go in hopes to avoid a nasty lawsuit. I just keep thinking of what I tell my daughter, "you don't get into as much trouble if you tell the truth." I do not have any ill intentions, however, from a patient's point of view, it makes it easier to think about a lawsuit when one knows there is dishonesty involved, not that those are my intentions, but after all, I am human and do think about it sometimes. I would like to commend you as a surgeon for your point of view of screw ups, it humanizes you as well as other doctors that follow suit. Doctors, especially surgeons, are placed far above on a pedalstool (rightly deserved by most)and people forget not only are they human, but they have emotions too. So thanks for this article. I see some of you in this surgeon, however I'm afraid he's turning direction, he must have taked to his legal department or maybe his insurance company, who knows? I was way more accepting of this and the "complication" before our last office visit. Now I don't know what to think. Thanks again for your perspective!

I don't know what to think either, Charlie. I have the same impression of your surgeon that has evolved with you. Were you to take action, I'd assume there is documentation of what the original status was: in his op notes, in the radiology reports, and those of the GI doc.

On the other hand, it sounds like the major issue with you is the sense of disappointment and, for lack of a better work, betrayal. So maybe you could tell him that and see how he responds. Or not.

In any case, as with the commenters above, I'm sorry for what you've had to go through, and for the extent to which a fellow surgeon may not be living up to his responsibilities.

On December 7/06 I had an open cholecysectomy, because of "extensive adhesions" from previous emergency surgery to remove a ruptured spleen. I was told that my bile duct, gall bladder and liver were all "gummed" up together with scar tissue. During the process of separating the gallbladder and cystic duct my common bile duct was severed (not nicked, but cut in half). The surgeon quickly reattached it somewhere on my duodenum. I was plagued with upper right quadrant radiating to the middle back pain on and off until I was hospitalized5 months later, because there was a bile duct stricure and bile was backup up into my liver, to the point where I could not eat anything. A cholangiogram was performed and a tube was inserted through the ducts in my liver to all bile to flow properly. After 3+ weeks it was removed and I was advised that I might get sick again, or I might not, but if I got the same pain, accompanied by fever to go back to the hospital for pain meds and antibiotics. Jump ahead to Dec. 2008 - during the course of 5-6 weeks I started getting sick again, extreme fatigue, pain that would come and go and then I got the fever. Not a high fever, but one that spiked about 38.5, then down to normal, then back up again. Ultrasound showed dilated bile duct, so back into the hospital again, where an ERCP and Sphincterotomy (sp?) was performed. Infection and pain finally went away and I was referred to a GI specialist. Two more scope procedures, but no answer - just that I might be a "sludge" former. Sounds funny - even to me - who has to deal with this crap every day. Jump forward to July 2009, started getting extreme fatigue and the pain. Tests shows my elevated liver enzymes were even more elevated. I had another bought of infection and pain, but GI specialist was too booked up to see me, and I didn't have the energy to explain the whole thing to an emerg. doctor. Fortunately I fought the infection off myself. For over three years I have had elevated liver enzymes - GGT and Alk Phos, and when I get an infection ALT/AST and sometimes bilirubin go up. I have suffered from extreme fatigue since the 2006 surgery and building a quality of life has been difficult because I never know when I will get sick again. I only know I will. I have now seen one of the top surgeons in my province (cancer and transplant surgeon). He told me that he knew what the problem was, and he could fix it, AND he questioned why I had not been referred to him sooner. I'm not sure what type of surgery he will be doing, but it it major open surgery involving reconstruction of my bile duct. Oh yeah and did I mention that the surgical report is kind of vague as to exactly where the injury is. In fact by GI Specialist asked me recently if the surgeon told me exactly where the injury was because she didn't know based on the original surgical report, and couldn't tell from the ERCP, as dye would not go into certain parts of the bile duct! So this has been my life for over three years. Some people go on vacation, I have medical procedures. Personally I'd rather go one a tropical vacation. I've spent alot of time trying to research my medical problem and it is difficult to find information on the internet. I think the surgery might be called a choledochoduodenostomy. Do you know if this is correct.

You've had a hell of a bad ride, anonymous. It's a nightmare. The good news is that it sounds as if you have a surgeon who knows what he's doing.

Hard to know exactly what happened and what was done the first time around, but it seems pretty certain the problem is stricturing at the area of injury/repair. It was probably inevitable that, once that occurred, surgery of some sort would be needed, ultimately.

There are various surgical solutions to the problem, depending on the exact anatomy. Choledochoduodenostomy is among them, although that might be what was done the first time around, from your description. Another is Roux-en-Y choledochojejunostomy; and there's Roux-en-Y hepaticojeunostomy. The difference is mainly where the hook up is done, ie how close to the liver.

Here's a decent image of the anatomy. You can see how the intestine is divided, and reattached leaving a free end. That construction is done for many hookups.

Thank you Dr. Schwab for your prompt response. I've now obtained a copy of the surgeon's report from my GP and the procedure will be a choledochoduodenostomy. This will be the second time this procedure will have been done on my body, but this time by a surgeon with much more expertise with these types of injuries. Apparently I like have contaiminated static bile and stricturing of the anastamosis, and am at high risk for sepsis, because I don't have a spleen. Your response was greatly appreciated. The surgeon has strongly recommended that next time I get sick, I head immediately for Emerg. and he will perform the surgery as an emergency procedure (given that the wait list is 1-2 years). Have a great Christmas!

Hi My mom had a common bile duct injury. It has been 4 years now since the injury. She has had a tube that goes from the outside of her side through the reconstructed bile duct. it has to be changed every 8 weeks. Some months she has to return to the hospital several times a month, because it leaks out on her skin. A couple of weeks ago, she had to go to the hospital six times because of this matter. Do you know of any surgeon that specializes in this repair. She tired of these problems, that have taken her life away. She lives in Iowa, and goes to Iowa City University Hospital every 8 weeks or sooner.

diane j-m: I'd agree it's worth considering a surgeon with lots of experience with biliary surgery. An operation is theoretically possible, depending on the anatomy, and it could rid her of the tube and its problems.

I'd suggest searching the term "biliary pancreatic surgeon." I know of a couple: in San Francisco, at UCSF, Lawrence Way. He might or might not still be doing surgery but he'd be a very knowledgeable source of info. Also, in Boston, Andrew Warshaw. Another, in Portland Oregon, is Karen Deveney. Any of them might at least be able to suggest people nearer to you. Karen is a friend. I guess dropping my name would get her attention, although she'd likely help without it...

My mother had a lap. chole 5 1/2 years ago with the end result of a common bile duct injury. To date, my mom has had numerous hospital stays. She has had the hepatojejunostomy reapir by a wrold known surgeon who was unforteuneately anable to save her right hepatic duct due to its extent of injury sustained. The right lobe of her liver has since atrophied because of this. She has had numerous drains placed and removed and then placed again....(over and over like a broken record), several dilitations, scans etc. She is weak and suffers from fatigue. She is very depressed and has lost any hope in chances that someday she MAY feel any normalcy again or will this kill her....there is a small percentage that given everything her now Dr's and Surgeons are doing for her to repair the damage and stricturing in her left hepatic duct, that it may not work and eventually she may be diagnosed with liver failure. This is all becuase the initial surgeon who completed the cholecystectomy was uncertain of her anantomy, proceeded anyway through the transcection without another thought as to convert or obtain an intraoperative cholangiogram. Furthermore, after transection, did not take steps to make sure structures that shouldnt be cut, were intact. Emergency care was not given to my mother until almost 4 days post op when she was sent to another facility for extensive treatment. The surgeon and facility involved in the initial operation, ignored my mothers cries of pain, telling her to just take her pain medicine. I am very disgusted with the initial surgeon who WILL NOT admit his mistake and expalins it all away. I hope that he NOW proceeds with caution in doing surgery and utilizes tools (scans, etc.) that are at his disposal thanks to technology, to ensure future patients safety and quality of life. Thanks to him, my moms quality of life is next to nothing!And thank goodness my mother has her family who loves her very much and stands beside her win or lose! We love you mom!!!

This a true doctor.Far and few in between.A doctor who can admit mistakes and actually communicate with a patient is old school.Why are there not many more like this doctor.We truly need them now.Amazing!

Goodness this sounds like my life except my bile duct was severed during gallbladder removal in 1993 and i went through reconstructive surgery and now i have episodes of extreme abdomanol pain, vomitting,fatigue all the time. These episodes started in 2007. I am tired. I have applied for SSDI because of this. I was 26 when i originally had the first surgery. I wont have anymore surgerys. I think i am affraid .

I made a comment regarding my situation on 03/13/2013 and havent been responded to. What happened to me years ago was horrific i dont have no physical ability to work a steady job and have many other issues that i had to apply for SSDI and it would be nice to hear some response on what my chances are due to the fact i have the episodes spiratically.. all of my mysery was at the hands of a dr and would like something to finally go right. Life isnt fair and i lived the life of the hand that was dealt me.

Anonymous: there's a comment above from 3/16, but not 3/13. Assuming you are the same anonymous, but just miswrote the date, your previous comment didn't seem to be asking for a response, so I didn't write one. It's a terrible situation, and I hate hearing such things. I'm sorry to hear of your struggle. You said you weren't intending to have more surgery, so it's hard to know what other options there are.

The only advice I can give, since situations like yours are so complicated that it's impossible to make recommendations without knowing all the details, is to seek help at a major medical center if that's feasible. Search for "biliary-pancreatic surgeons" in your area, or contact the surgery department of the closest center associated with a surgery training program.

Telling the truth, even if a little sugar coated, would have made me feel better when my surgeon clipped a duct. Instead, I heard it's gas, constipation, pain is caused by the gas used. Then the question "Have you ever had surgery, if you had you would know that this is normal". (yes, I've had 3 csections) The whole time with this look of you are really bothering me for no reason. It took a week of excruciating pain, 3 hospital discharges, hundreds of tests, and time away from my family before we knew the problem. His new answers or comments for what happened are what I like the most. I've only had this happen to 1 other patient out of probably 3000, but she wasn't as badly sick as you. He repeated this several times, but then his numbers would change! Maybe he thought I was doped up on pain meds & not really listening. If he handled the situation appropriately, as you did, I would probably still be upset that it happened to me. Instead, I'm wishing that he could experience EXACTLY what I did for a total of 5 months. I'd even tell him he's just constipated, but I wouldn't give him med to help the problem (yes, he did that to me too). We need more physicians like you!

My sister has just had a gallbladder op go wrong. She was left screaming in agony for days before they investigated and found out the extent of the issue. Her surgeon lied to her face, saying it was just a nick and nothing serious then went on leave. It was left to another doctor to tell her it had been completely cut.....we're still not clear on whether a section was removed. She's now had a repair op done to bypass and connect to the intestine (again, we think, because info is given sparingly) We've been given no info on possible long term effects despite several doctors making off the cuff remarks to my sister that lead her to believe long term health and QOL is compromised. Can anyone shed any light on what these might be?

I'd say she's certainly entitled to a full explanation to her satisfaction. The surgeon who did the reconstruction ought to do so. There are a couple of different ways to hook things back up, but the exact method probably doesn't matter much as long as bile is draining back into the intestine.

I'd guess the surgeon won't be able to make any sort of specific predictions about quality of life. The main risk is that the area of hookup could eventually scar down and cause a partial blockage of bile flow.

This may well never happen, in which case her quality of life would be expected to be normal. If it were to happen, then, depending on the anatomy of the hookup, the scarred area could be dilated, either endoscopically or via a catheter passed through the liver. Both relatively simple, not requiring surgery.

The surgeon ought to be able to say what approach might be used if it were necessary. Hopefully, it never will.

I went through having my common bile duct cut and ended up having biliary bypass, now a year and half later it is closing up. I am unable to eat now for about a month except bland food. I'm starving. I am afraid to go under the knife again, but have no choice. My surgeon was happy to blame it on my anatomy, play like he was unsure if he cut it, I wake up from surgery with a straw in my mouth and people telling me to drink while a machine surrounded me ---that evening. I did get shipped off for multiple surgeries and a 2 week stay. Huge scars, many miles away from my young child, alone. I can't tell you how much $ I had to pay out, now same thing the following year. I can't afford it. I'm not one to believe in lawsuits, so I am torn, but feel my life may end up cut short. I'm always worried about it. I cannot leave my job, although we planned to relocate prior to this. I have no choice but to stay. I'm really hurt by it. I am considering talking to a lawyer in light of the new surgery required. Not being able to eat is pure he**.

So my 89 year old father, very healthy for his age,(only takes Zantac for heartburn), needed his gallbladder out as it became infected. Long story, inadvertently clamped his CBD. Two days afterward, found bile in drain, and did ERCP to stent; followed up with MRCP, realized CBD clamped. Surgeon claims inflammation caused his error. When asked if he should have gone in to better visualize my dad's anatomy at the time, he claimed that "he never likes to second guess himself". That, to me is a frightening statement. My dad is being sent home with a drain for the next three weeks, and will return for surgical repair. Again, he's 89. Should I look for an alternative surgeon? I just don't have the confidence. Any advice? Thanks

That's a really unfortunate situation, all right. I agree that when a complication occurs, second guessing is what's called for; i.e, if a surgeon -- or anyone else, for that matter -- causes a problem it seems imperative to think about how things might have been handled differently, and whether they should have been.

If the response was a little clumsy, it doesn't necessarily he shouldn't be trusted; that's something you and your father have to decide, based on your feelings, I guess. It's certainly not the first time such a thing has happened with laparoscopic gallbladder surgery, even to excellent surgeons.

The bigger question relates to what's planned as a way of surgical repair. There are at least a couple of options, and it might not be possible to choose with certainty until the operation is under way. But I'd think he should be able to say what he thinks the options are, where the clip appears to be (the closer to the liver the more difficult the operation), and how experienced he is in this sort of reoperative repair or reconstruction.

I'd bet you'd have a better handle on how you feel about it after such a conversation. OTOH, to decide now that you want another opinion/explanation is perfectly reasonable. The key, in my view, is to have a surgeon reasonably experienced in this sort of reoperative surgery.

Good luck. If you feel like it, when it's all resolved, I'd love to know what was done.

About Me

I'm a mostly retired general surgeon. With my surgical blog, my intention is to inform, entertain, and possibly educate the reader about surgery, and about the life and loves of a surgeon: this one, anyway. Don't know what I'm thinking, doing a political blog, too.
In an amazing coincidence, I've also written a book, "Cutting Remarks; Insights and Recollections of a Surgeon." It's about my surgical training in San Francisco in the 1970s, aimed at the lay reader with the goal of entertaining with good stories, informing with understandable details of surgical anatomy, procedures, and diseases. Knowing you, I bet you'd enjoy it. In fact, if you like Surgeonsblog, you'll absolutely love the book!

Boring, Unoriginal, but Important Disclaimer:

What I say here is as true as I can make it, based on my experience as a surgeon. Still, in no way is it intended as specific medical advice for any condition. For that, you need to consult your own doctors, who actually know you. I hope you'll find things of interest and amusement here; maybe useful information. But please, please, PLEASE understand: this blog ought not be used in any way to provide the reader with ideas about diagnosis or treatment of any symptoms or disease. Also, as you'd expect, when I describe patients, I've changed many personal details: age, sex, occupation -- enough to make them into no one you might actually know. Thanks, and enjoy the blog.